Reconstruction of Soft Tissues of the Postamputation Lower Leg Stump with a Free Anterolateral Thigh Flap for Optimal Prosthesis.

Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of disability severely restricts their proper functioning in social and professional life. The commonly used significant reduction of the bone length for local coverage limits rehabilitative options to the less comprehensive prosthesis. We aimed to describe a delayed reconstruction with soft tissues of the lower leg stump using free anterolateral thigh flap as an alternative surgical method allowing for optimal prosthesis. A 20-year-old patient was consulted because of right lower leg stump, covered only with a skin graft following posttraumatic amputation. Previously, the patient had ineffective attempts of using a prosthesis. He asked to determine the possibility of recovering the functionality of the lower limb. We performed reconstruction of soft tissues of the stump with a free anterolateral thigh flap. Postoperatively, the patient achieved good coverage of the remaining part of the tibia with a thick layer of soft tissues, allowing the subsequent adequate forming of the stump. Therefore, a fixed prosthesis with the dynamic foot could be implemented. A significant increase in physical activity contributed to a full return to the patient's professional and private life. In conclusion, the free anterolateral thigh flap provides a robust amount of good-quality tissues for supportive function of the lower limb stump. The resulting adaptation of the stump to numerous modern prosthetic devices significantly increases the range of physical activity and contributes to the full return of the patient to their professional and private life.

Histological Properties of Adipose Tissue as an Autologous Tissue Filler Harvested from Different Donor Areas and Impact of Centrifugation.

Background: As a burgeoning technique in reconstructive and aesthetic surgery, lipofilling's success is hindered by the unpredictability of graft integrity and quality. This study addresses the critical need to enhance consistency and reproducibility by exploring the clinical utility of adipose tissue from specific body areas, considering the influence of patient-specific factors and mechanical processing on fat graft integrity and morphology. Methods: In a prospective, randomized, single-blind study, 52 patients undergoing surgical reconstruction due to significant deformities were enrolled. Lipoaspiration from four areas was performed. Adipose tissue was compared using five parameters of tissue damage and 10 parameters of graft integrity, assessed immediately postcollection and after centrifugation. The study aimed to evaluate the structural integrity and clinical applicability of adipocytes. Results: Morphological assessment revealed no significant differences in adipose tissue quality across donor sites, suggesting consistent graft quality regardless of the harvesting location. Centrifugation induced more morphological damage than noncentrifuged samples, but the overall graft integrity was maintained due to increased cell density. Higher graft acceptance parameters were noted in noncentrifuged samples compared with centrifuged ones. Conclusions: Despite centrifugation-induced morphological changes, adipose tissue integrity remains relatively unaffected, supporting a flexible approach to donor site selection. The consistent quality of adipose tissue underscores the potential for autologous fat transplantation across various clinical scenarios. Optimizing graft processing techniques is crucial for enhancing the predictability and efficacy of lipofilling.

Achieving Harmonious Feminine Proportions: A Comprehensive Study on Breast Harmonization with Nanotextured Implants.

Background: The prevalence of breast augmentation as a strategy for achieving idealized feminine proportions, consistent with contemporary beauty standards, has increased notably. This study focuses on the use of nanotextured implants, examining their efficacy in enhancing body symmetry and conforming to current aesthetic ideals. Methods: Conducted as a prospective cohort study, this research included women who underwent breast augmentation using nanotextured ergonomic implants from 2017 to 2023. A personalized methodology was applied, incorporating an array of anthropometric measurements and individual motivations to inform the selection of implants. The techniques used aimed at fostering a natural aesthetic, coupled with an extensive postoperative follow-up to evaluate outcomes and identify any complications. Results: The study involved 1000 participants, with findings indicating a marked improvement in breast and overall body proportions, in line with targeted aesthetic principles. High levels of patient satisfaction were observed, with more than 90% reporting favorable aesthetic results and a low incidence of complications. These findings emphasize the effectiveness and safety of nanotextured implants in achieving the desired aesthetic goals. Conclusions: The study underscores the efficacy of nanotextured implants in attaining balanced feminine proportions, aligning surgical results with modern beauty ideals and enhancing personal well-being. It highlights the significance of a tailored approach in breast augmentation, which encompasses not only the physical aspects of aesthetic enhancement but also the psychological and social facets of patient contentment.

Aesthetic Potential and Safety Profile of Nanotextured Breast Implants in 1000 Cases of Breast Augmentation: Evaluation of a Single-Center Experience.

BACKGROUND: Nanotextured implants, an innovation in implant technology, are designed to enhance tissue interaction, reduce inflammation, and mitigate complications of traditional implants. OBJECTIVES: The aim of the study was to evaluate the aesthetic potential and safety profile of nanotextured breast implants in breast augmentation from a single-surgeon experience. METHODS: This prospective cohort study included 1000 patients who underwent breast augmentation with nanotextured implants. Aesthetic outcomes were assessed with direct measurements and BCCT.core software, focusing on breast projection, symmetry, and upper pole fullness. Patient satisfaction was measured with BREAST-Q and overall satisfaction surveys. Safety profiles were evaluated based on the incidence of complications such as infection, hematoma, capsular contracture, and implant rupture. Statistical analyses were conducted to assess the outcomes. RESULTS: The study found significant improvements in aesthetic outcomes, with 92.8% of cases achieving substantial aesthetic enhancements. Patient satisfaction was high, with 96.4% of patients reporting enhanced self-esteem and contentment. The safety profile was favorable, with a low incidence of complications (0.7% requiring revisional surgery) and no major complications reported. Long-term follow-up data indicated sustained aesthetic outcomes and a stable safety profile. CONCLUSIONS: The synergistic quality of nanotextured implants in relation to the natural breast gland tissue is defined by a significantly wider range of aesthetic options. The findings of this study underscore the positive impact of nanotextured breast implants on enhancing the aesthetic potential of breast augmentation and their contribution to a low incidence of complications.

Advancements in Aesthetic Breast Augmentation: Evaluating the Safety, Efficacy, and Naturalistic Outcomes of Ergonomix2 Implants.

BACKGROUND: This pioneering study evaluates the safety, efficacy, and Aesthetic outcomes of Ergonomix2 Motiva Ergonomic Implants in breast augmentation. It aims to assess their capability to offer more natural touch and dynamics, delineate the learning curve for surgical techniques, and examine their safety profile compared to Ergonomix1 implants. MATERIALS AND METHODS: A prospective cohort study was conducted, comparing 31 patients who received Ergonomix2 implants with a control group of 51 patients with Ergonomix1 implants. Eligible patients were those seeking Aesthetic breast augmentation without prior surgeries or chronic illnesses. Detailed documentation of surgical techniques, implant characteristics, and patient demographics was performed. The study assessed surgical learning curve, implant positioning accuracy, and short-term and early complications. Aesthetic outcomes were evaluated using the BreastQ questionnaire and quantitative elastography. RESULTS: Patients with Ergonomix2 implants showed significant improvements in Aesthetic outcomes, including breast contour symmetry and natural feel. The learning curve demonstrated a decrease in surgical time and higher implant positioning accuracy. The safety profile was favorable, with a low complication rate and high patient satisfaction levels. Ergonomix2 implants exhibited enhanced softness and pliability, closely mimicking natural breast tissue, as confirmed by elastographic analyzes. CONCLUSIONS: Ergonomix2 implants represent a significant advancement in Aesthetic breast surgery, offering natural-feeling and dynamically adaptable outcomes. Despite the promising results, the need for specialized surgical techniques and further research on long-term safety and efficacy is emphasized. This study contributes foundational knowledge to the field of ergonomic breast implants and their application in modern plastic surgery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimizing precision rhinoplasty: comprehensive preoperative planning with nasal computed tomography for functional and aesthetic enhancement.

BACKGROUND: The evolving field of rhinoplasty increasingly recognizes the importance of clinical expertise over routine preoperative nasal computed tomography (CT) for planning surgical interventions. This study evaluates the clinical utility of preoperative nasal CT in enhancing the precision of open structured rhinoplasty, focusing on both functional and aesthetic outcomes without compromising patient safety through unnecessary radiation exposure. The study aimed to assess the impact of preoperative nasal CT on surgical planning and intraoperative maneuvers. METHODS: A prospective cohort study involved patients undergoing open structured rhinoplasty with or without preoperative nasal CT. Participants were divided into a study group, receiving preoperative nasal CT, and a control group, undergoing rhinoplasty without such imaging. Surgical modifications were tailored based on CT findings, with outcomes evaluated through postoperative nasal airflow and aesthetic satisfaction. RESULTS: The study included 205 patients in the CT group and 514 in the control group, with comparable demographics. The CT group demonstrated significant improvements in nasal breathing and higher aesthetic satisfaction postoperatively, with a notable decrease in the NOSE score and an increase in the ROE score compared to the control group. Minor complications were observed in a small percentage of the CT group, showcasing a nuanced approach to addressing individual anatomical variations. CONCLUSIONS: Preoperative nasal CT in open structured rhinoplasty significantly enhances surgical precision, optimizing functional and aesthetic outcomes. This study underscores the utility of preoperative CT in individualized surgical planning, suggesting its pivotal role in the advancement of rhinoplasty practices. Future research should explore long-term benefits and further validate these findings across diverse populations.

Enhanced revision rhinoplasty with processed costal cartilage guided by preoperative computed tomography and 3D scanning.

BACKGROUND: Revision rhinoplasty presents unique challenges, particularly in achieving structural integrity and aesthetic harmony. This study explores the efficacy of costal grafts in addressing these challenges, focusing on anatomical corrections and patient outcomes. MATERIALS AND METHODS: A prospective analysis was conducted on patients undergoing revision rhinoplasty with costal grafts. An algorithmic approach was applied to tailor the surgical technique to individual anatomical needs, documented through pre- and postoperative assessments, including CT imaging and 3D scanning. RESULTS: A total of 34 patients were included. Significant improvements were noted in nasal structure and function post-surgery. The mean NOSE score improved from 94.47 ± 5.48 preoperatively to 12.59 ± 13.43 postoperatively, and the mean ROE score increased from 18.44 ± 10.02 to 92.65 ± 13.00, indicating substantial enhancement in both nasal airway function and patient satisfaction. The use of costal grafts facilitated effective corrections for a broad spectrum of nasal deformities, with a complication rate of 2.94%. CONCLUSIONS: Costal grafts in revision rhinoplasty offer a versatile and effective solution for complex nasal deformities. The algorithmic approach used in this study enhances repeatability and outcomes, suggesting a promising avenue for achieving desired aesthetic and functional results in revision cases. Further research is warranted to optimize techniques and evaluate long-term outcomes. LEVEL OF EVIDENCE: II.

Multiple Symmetrical Scrotal Lipomatosis: Diagnosis and Treatment with Comprehensive Summary of the Entity.

Multiple symmetrical lipomatosis is a rare diffuse presentation of the progressive accumulation of deposits of nonencapsulated masses of adipose tissue. The characteristic image of this disease is bilateral swelling in the neck, the upper part of upper limb, pelvic rim, back, and thighs. We report a case of unusual localization of benign scrotal symmetrical lipomatosis with ultrasound and histological appearances of the scrotal lipomatous masses, together with treatment. Scrotal lipomatosis should be considered as a rare differential diagnosis of scrotal swelling, and excisional lipectomy should be considered in preference over liposuction. Patients should be offered counseling for infertility.

The Influence of Polyphenol Compounds on Human Gastrointestinal Tract Microbiota.

: Polyphenols form a diverse group of compounds containing at least two hydroxyl groups in their chemical structure. Because of the common presence in plant kingdom, polyphenols are considered a significant component of food and an important group of compounds with antioxidant properties. The absorption of polyphenols present in food depends mostly on the activity of intestinal microflora. However, little is known about the processes and interactions responsible for such phenomenon in guts ecosystem. There are only few available publications that examine the effect on polyphenols on intestinal microbiota. Therefore, this work will focus on describing the relationship between polyphenol compounds present in food and bacteria colonizing the intestines, their mechanism, and impact on human's health.

Resveratrol's Impact on Vascular Smooth Muscle Cells Hyporeactivity: The Role of Rho-Kinase Inhibition.

Resveratrol (3,5,4'-trihydroxystilbene) is a chemical compound belonging to the group of polyphenols and flavonoids. The aim of the present study was to determine the influence of resveratrol application along with certain modulating factors, such as 8Br-cGMP-activator of cGMP-dependent protein kinases, HA-1077-Rho-kinase inhibitor, and Bay K8644-calcium channel agonist, on VMSCs constriction triggered by phenylephrine. Resveratrol at a dose of 10 mg/kg/24 h administered for 4 weeks reduced the reactivity of the arteries to the pressure action of catecholamines. Tests performed after four weeks of resveratrol administration showed that 8Br-cGMP at the concentrations of 0.01 mM/l and 0.1 mM/l intensifies this effect. Simultaneous resveratrol and Bay K8644 administration led to a significant decrease in contractility compared to the vessels collected from animals (Res-). This effect was dependent on the concentration of Bay K8644. Resveratrol seems to be counteractive against Bay K8644 by blocking L-type calcium channels. As the concentration of HA-1077 increased, there was a marked hyporeactivity of the vessels to the pressure effects of phenylephrine. The results indicate synergy between resveratrol and Rho-kinase inhibition.

Impact of Vitamin D on Physical Efficiency and Exercise Performance-A Review.

Vitamin D deficiency amongst athletes and the general population seems to be a prominent problem. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship between vitamin D and bone health. Moreover, its concentrations are associated with muscle function and immune response in both the general and athletic populations. Vitamin D level is strongly connected with the presence of VDRs (vitamin D receptors) in most human extraskeletal cells. Expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation is caused by an exposure of skeletal muscles to vitamin D. The aim of this review is to summarize current understanding of the significance of vitamin D on exercise performance and physical efficiency, as well to analyze the impact of vitamin D on multiple potential mechanisms. More high-quality research studies, considering free 25(OH)D as a better marker of vitamin D status, the baseline level of 25(OH)D and multiple pathways of vitamin D acting and usage in athletes are required.

Intraoperative diagnosis of sentinel lymph node metastases in breast cancer treatment with one-step nucleic acid amplification assay (OSNA).

INTRODUCTION: The aim of the study was to evaluate the clinical usefulness of a one-step nucleic acid amplification assay (OSNA) for intraoperative detection of metastases to sentinel lymph nodes (SLNs) in comparison to examination of frozen sections, and to summarize the results of previous studies. MATERIAL AND METHODS: We enrolled 98 patients aged 58.13 ±10.74 years treated surgically for breast cancer, and 99 biopsies of SLNs were followed by analysis of 105 SLNs. The central 1 mm slice of SLN was used for examination of frozen sections, whereas 2 outer slices of SLNs were analyzed intraoperatively with OSNA. Detection of isolated tumor cells (ITC), micrometastases or macrometastases with OSNA extended surgery to axillary lymph node dissection. Congruency of results was assessed between OSNA and examination of frozen sections. RESULTS: One-step nucleic acid amplification assay detected metastases in 29/105 SLNs in surgery of 27/99 breasts, including ITC in 3/29 SLNs, micrometastases in 12/29 and macrometastases in 14/29. One-step nucleic acid amplification assay detected significantly more metastases to SLNs than examination of frozen sections (p < 0.0001). All 8 inconsistent results were positive in OSNA and negative in examination of frozen sections; ITC were identified in 2/8 SLNs and micrometastases in 6/8 SLNs. Sensitivity for OSNA was calculated as 100%, specificity as 90.47%, and κ was 79.16%. CONCLUSIONS: One-step nucleic acid amplification assay analysis allows rapid and quantitative detection of mRNA CK19 with high specificity and a low rate of false positives. One-step nucleic acid amplification assay is a reliable tool for intraoperative diagnosis of whole SLNs during surgery of breast cancer. One-step nucleic acid amplification assay minimizes the need for secondary surgery and avoids delays in the adjuvant treatment.

Autologous fat transfer to the subcutaneous tissue in the context of breast reconstructive procedures.

Autologous fat transfer (AFT) is an appropriate technique for aesthetic rejuvenation of the face, aesthetic enhancement of hands, correction of the facial appearance in various disorders and constitutes a surgical alternative of treatment of numerous breast deformities ranging from distorting posttraumatic scars, post-eczema lesions, post-burn deformities to partial or total breast reconstruction. Our work is aimed to familiarize dermatologists with the technique of harvesting and implanting the aspirate of adipose cells in patients consulted for deformities of the breast. In addition, the review summarizes the most common applications of AFT in the breast reconstructive procedures. In summary, AFT is an oncologically safe, relatively complication-free, minimally invasive surgical technique, which can be used to correct a wide range of deformities, which are commonly seen by dermatologists, in the area of the face, trunk and extremities. The procedure can correct a wide range of breast deformities, from contour or single quadrant deformities up to the state after mastectomy.

Co-existence of chronic non-communicable diseases and common neoplasms among 2,462 endocrine adult inpatients - a retrospective analysis.

OBJECTIVE: To analyze the coexistence of chronic non-communicable diseases (NCDs) and common neoplasms among endocrine adult inpatients. MATERIALS AND METHOD: The retrospective analysis was performed using clinical data of 2,462 adult patients (2,003 women and 459 men), hospitalized in the reference endocrine department. Diagnoses of 18 types of benign tumours and 16 types of malignant tumours, together with the most common 25 NCDs and demographic parameters, were all collected from the medical records. The most frequently found 6 types of benign tumours (of thyroid, pituitary, uterus, breast, adrenal and prostate) and 4 types of malignant tumours (of thyroid, breast, prostate and uterus) were taken for further statistical analyses. RESULTS: Age predicted the existence of accumulated as well as individual types of benign and malignant tumours, whereas BMI predicted the occurrence of accumulated and some individual types of benign tumours. Accumulated as well as individual types of benign and malignant tumours coexisted more frequently with several NCDs, such as diabetes, hypertension, metabolic syndrome, osteoporosis, Graves' disease, coronary artery disease, state after cholecystectomy, thus being disorders usually resulting from excessive exposure to harmful environmental factors. The most distinct coexistence was found between breast cancer and metabolic syndrome, between breast cancer and Graves' disease, between cancer of the uterus and type 2 diabetes, between cancer of the uterus and metabolic syndrome, and between cancer of the uterus and dyslipidemia. CONCLUSION: The results obtained indicate a significant relationship between the most common NCDs and several cancers in endocrine adult patients, which suggests that the prevention of the former may reduce the frequency of the latter.

[Total upper and lower eyelid reconstruction using an expanded forehead flap supplied by the frontal branch of superficial temporal artery]. / Rekonstrukcja tkanek miekkich obu powiek za pomoca plata z czola opartego na galezi czolowej tetnicy skroniowej powierzchownej.

Eyelids form the protective eye apparatus. Loss of upper or lower eyelid can lead to infection, vision impairment or even blindness. Although there are many techniques for upper or lower eyelid reconstruction, there are only few articles to report simultaneous reconstruction of both eyelids. The aim of this study is to present a two-stage eyelid reconstruction method using the forehead flap. A 60-year-old woman was admitted to our Department with animal bite wounds in the left periorbital area. During the first operation, the eyelid defect was covered with forehead flap and in the second stage, horizontal incision was created in the flap above the eyeball to form a palpebral fissure. During this two-step surgical treatment, both eyelids of the left eye were reconstructed. The length and width of palpebral fissure were 30 mm and 14 mm, respectively. The patient was satisfied with the surgery outcomes. Reconstruction of both eyelids with forehead flap supplied by the frontal branch of the superficial temporal artery provides the elementary protection to the eyeball, enables vision preservation and offers good aesthetic result.

Preoperative implant selection for two stage breast reconstruction with 3D imaging.

Implants used for two-stage breast reconstruction are selected exclusively on the basis of the directly measured linear parameters. Therefore, the relevant implant is not always chosen despite the wide range of available products. The aim was to analyze the clinical usefulness of three-dimensional (3D) imaging in the breast implant selection. In 50 patients after unilateral two-stage breast reconstruction, height, width, projection and total volume of both breasts were triply obtained with measuring tape (anthropometric method), thermoplastic casting (thermoplastic method) and 3D imaging (optical method). We measured skin fold thickness with skin caliper. In the optical method, we subtracted the covering tissues and calculated the parameter - "estimated breast implant volume" (EBIV), together with the corresponding "anthropometrically estimated breast implant volume" (aEBIV) in the anthropometric method. Reliability of the three methods was described as repeatability and accuracy, both quantified with parameters: "technical error measurement" (TEM) and "reliability factor" (R). Repeatability showed variation among the repeated measurements. Accuracy determined variability between the real volume of the implant used for reconstruction and the obtained volumetric parameters. Repeatability was the highest for the optical method, comparing to anthropometric and thermoplastic methods (p<0.0001). Accuracy was the highest in the optical method for EBIV, comparing to aEBIV in the anthropometric method and the total volume in three methods (p<0.0001). Level of accuracy for EBIV was in the range of variability among the commercially available implants (p>0.05). In conclusion, implants for breast reconstruction are precisely selected with the 3D scanning method, in comparison to widely used direct measurements or thermoplastic casting.